Joint Preservation in Bilateral Avascular Necrosis of Femoral Head through Ayurvedic Management: A Two-Year Radiological Follow-Up Case Report.

Abstract

Background: Avascular necrosis (AVN) of the femoral head is a progressive osteonecrotic disorder that frequently leads to femoral head collapse and subsequent joint replacement in advanced stages. Conservative approaches aimed at joint preservation are therefore of significant clinical interest. Aim: To evaluate the clinical and radiological outcome of Ayurvedic management in a case of bilateral avascular necrosis of the femoral head. Case Description and Methods: A 33-year-old female presented with severe pain in both hip joints, difficulty in performing floor activities, and antalgic gait. Magnetic resonance imaging (MRI) findings were suggestive of bilateral avascular necrosis of the femoral head. The patient underwent Panchatikta Ksheera Yoga Basti during hospitalization, followed by Matra Basti with Asthi-Shrinkhala Ghrita at home, and a subsequent repeat course of Panchatikta Ksheera Yoga Basti. Oral Ayurvedic medications were administered throughout the treatment period according to symptomatic variations. Clinical improvement and radiological changes were assessed using serial MRI evaluation. Results: Significant clinical improvement was observed with reduction in hip pain within six months and improvement in gait and functional activities after approximately eighteen months. Baseline MRI demonstrated approximately 70–80% femoral head involvement bilaterally with Ficat stage III changes. Follow-up MRI after two years showed reduction of femoral head involvement to approximately 50–60% on the right side and 30–50% on the left side. The left femoral head demonstrated stage regression from Ficat stage III to stage II, indicating radiological improvement. Joint effusion noted in the initial MRI was absent in the follow-up imaging. During the follow-up period, a stress fracture of the right femoral neck was observed following a slip-and-fall incident. Conclusion: The present case demonstrates that structured Ayurvedic management may contribute to clinical improvement and radiological stabilization with partial regression of disease severity in bilateral avascular necrosis of the femoral head, suggesting its potential role in joint preservation strategies.